There has always
been a gap between psychological science and practice. In many ways, it
is no different from the natural tensions that exist between researchers and
practitioners in any field-medicine, engineering, education, psychiatry,
physics-when one side is doing research and the other is working in an applied
domain: their goals and training are inherently quite different. The goal of
psychotherapy, for example, is to help the suffering individual who is sitting
there; the goal of psychological research is to explain and predict the
behavior of people in general. That is why many therapists maintain that
research methods and findings capture only a small, shriveled image of the real
person. Therapy, they note, was helping people long before science or
psychology were invented. Professional training, therefore, should teach
students how to do therapy, not how to do science.

In
psychology, this divergence in goals and training was present at the
conception. Empirical psychology and psychoanalysis were born of different
fathers in the late 19th century, and never got along. Throughout the 20th
century, they quarreled endlessly over fundamental assumptions about the
meaning of science and truth. How do we know what is true? What kind of
evidence is required to support a hypothesis? To early psychoanalysts,
"science" had nothing to do with controlled experiments, interviews,
or statistics. In constructing what they saw as a "science of the
mind," psychoanalysts relied solely on their own interpretations of cases
they saw in therapy, of myths and literature, and of people.

The
field of psychology has traditionally been reluctant to subject novel and
controversial methods to careful scientific evaluation. This reluctance has
left a major gap.

Therefore
widely held beliefs, promoted by many psychotherapists, that have been
discredited by empirical evidence are for example:

•
Almost all abused children become abusive parents.• Almost all children of alcoholics become alcoholic.• Children never lie about sexual abuse.• Childhood trauma invariably produces emotional
symptoms that carry on into adulthood.• Memory works like a tape recorder, clicking on at the
moment of birth.

Hypnosis can reliably uncover buried memories.

•
Traumatic experiences are usually repressed.• Hypnosis reliably uncovers accurate memories.• Subliminal messages strongly influence
behavior.• Children who masturbate or "play doctor"
have probably been sexually molested.• If left unexpressed, anger builds up like steam
in a teapot until it explodes.• Projective tests like the Rorschach validly
diagnose personality disorders, most forms of psychopathology, and sexual
abuse.

Other
unvalidated psychological treatments, include Thought Field Therapy and
Imago Relationship Therapy, for which essentially no published controlled
research exists.

Yet
among the workshops providing continuing education (CE) credits to therapists
are courses in calligraphy therapy, neurofeedback, Jungian sandplay therapy,
and the use of psychological theater to "catalyze critical
consciousness" Credits for critical incident stress debriefing, a
technique that has been shown to be harmful in several controlled studies.

One
can wonder whether individual differences exist among psychotherapists in their
attraction to pseudoscientific methods. For example, if a therapist is
attracted to one pseudoscientific method, will the therapist also be attracted
to others?

But
many today can receive a PhD in psychology without having acquired a core
understanding of the basic principles of critical and scientific thinking.

What
kinds of evidence are needed before we can draw strong conclusions?Are there alternative hypotheses that I have not considered?

The
importance of testing clinical assumptions empirically, let alone of
operationally defining terms.About confirmation bias or the principle of falsifiability,
and how these might affect diagnosis.

About
the social psychology of diagnosis: for example, how a rare problem, such as
"dissociative identity disorder" (see my article yesterday) or
"Munchausen by proxy" syndrome, becomes overreported when clinicians
start looking for it everywhere and are rewarded with fame, acclaim, and income
when they find it.

Why
are so many diagnoses of mental illness based on consensus-a group vote-rather
than on empirical evidence, and what does this process reveal about problems of
reliability and validity in diagnosis?

An
ethnographic study of the training of psychiatrists showed that psychiatric
residents learn how to make quick diagnoses, prescribe medication, and, in a
dwindling number of locations, do psychodynamic talk therapy, but rarely do
they learn to be skeptical, ask questions, analyze research, or consider
alternative explanations or treatments.

It
is surprisingly difficult for clinicians to learn from clinical experience.
This is not to say that clinical experience is never valuable. For example,
experience may help clinicians structure judgment tasks. That is, it may help
clinicians decide what judgments and decisions need to be made. Similarly, more
experienced clinicians may be better at knowing what information to collect in
an interview. However, experience does not seem to be useful for helping clinicians
evaluate the validity of an assessment instrument. Nor does experience seem to
help clinicians make more valid judgments when the task is structured for them
(e.g., when they are all given the same information).

Psychotherapists
who use pseudoscientific assessment and treatment methods continue to use them
in part because they have not learned from clinical experience that they do not
work. Empirical studies may raise questions about the validity and utility of
pseudoscientific methods, but clinical experience is less likely to do so. A
great deal of research has been conducted on cognitive processes, the nature of
feedback, and the reasons why it is difficult to learn from experience.
However, empirical studies have not focused on studying clinicians who use
pseudoscientific methods. That is, studies have not focused on understanding
why clinicians who use pseudoscientific methods have trouble learning from
experience. Put another way, no study has looked at the cognitive processes,
personality traits, and belief structures (cognitive schemas) of clinicians who
use pseudoscientific methods. Nor has any study looked at social factors that
may reinforce clinicians for using pseudoscientific methods.

But
there is also scant support for the Rorschach test, some promising avenues no
support for the Thematic Apperception Test( TAT) measure as it is
currently used in clinical practice, only very limited promise for holistic
scoring of some projective drawings, no support for anatomically detailed dolls
(ADDs) as a screening instrument for evidence of sexual abuse, and evidence
that the Myers-Briggs Type Indicator (MBTI) is a potentially reliable measure
that lacks convincing validity data. A lack of standardization in the use of
many of these techniques and an overreliance on unsubstantiated beliefs that
certain people possess special interpretive powers has thwarted the
possibility of advancing these techniques into the realm of scientifically
supported assessment strategies.

It
is also clear that self-help has not advanced substantially over the past three
decades and it is unlikely to advance over the next 30 years if prevailing
models are maintained. Unless a new direction is taken, there is no reason to
expect that the next Don't Be Afraid, published perhaps in the year 2010, will
be any more effective than the Don't Be Afraid of 1976 and 1941, or that the
next Mind-Power will be anymore effective than the -Wind Powers of 1987, 1912,
or 1903.

Case
Example 1: Possession

Following
an illustration of how reading material and psychological symptom
interpretation can increase the plausibility of an initially implausible memory
of witnessing a demonic possession. in an initial testing session, all of the
participants indicated that demonic possession was not only implausible, but
that it was very unlikely that they had personally witnessed an occurrence of
possession as children.

A
month after the first session, participants in one group first read three short
articles (in a packet of 12), which indicated that demonic possession is more
common than is generally believed and that many children have witnessed such an
event. These participants were compared with (1) individuals who read three
short articles about choking and (2) individuals who received no manipulation.
Individuals who received one of the manipulations returned to the laboratory
the following week and, based on their responses to a fear questionnaire they
completed, were informed (regardless of their actual responses) that their fear
profile indicated that they had probably either witnessed a possession or had
almost choked during early childhood.

When
the students returned to the laboratory for a final session and completed the
original questionnaires, they indicated that the two suggested events-witnessed
possession and choking-were more real than before. Additionally, 18% of the
participants indicated that they had probably witnessed possession. No changes
in memories were evident in the control condition. These findings provide
evidence that events that were not experienced during childhood and are
initially thought to be highly implausible can, with sufficient
credibility-enhancing information, come to be viewed as having plausibly
occurred in real life. (1)

2.
Space Aliens

Myra
was referred to a psychologist for relaxation training by her treating
physician. The referral was to a psychologist who specialized in pain relief.
During Myra's initial visits, the psychologist took virtually no history.
Nevertheless, after hypnosis, the psychologist informed Myra that her back
problems were a result of her having been molested by her father. The
psychologist further informed Myra that she mentioned visiting her favorite
uncle while she was hypnotized. The psychologist shifted to saying that her uncle
had molested her. While in a normal waking state, Myra had no memories of
abuse, either by her father or her uncle and took issue with the therapist's
claims of such abuse. At her next session, the therapist indicated that, during
another hypnotically induced state, Myra had remembered being abducted by a UFO
while at her uncle's home. The UFO descended into her uncle's backyard and had
taken her onboard a spacecraft that looked like the white "Inside of an
eggshell." There, she was reported to have been sexually examined by
aliens. This examination and subsequent examinations, performed while she was
lying on an table, were the cause of her back problems. The psychologist
hypnotized Myra in each of her sessions, maintaining that hypnosis was
necessary with clients abducted by space aliens because the aliens hypnotized
humans to force them to forget their alien encounters. Over the next 3 years,
the psychotherapist focused on uncovering, all of Myra's alleged encounters
with aliens. Myra felt that the therapist only seemed interested when she
cooperated by producing information concerning these purported encounters. She
reported that she began "to feel foggy, tired all the time, and out of
touch with my feelings about anything." The psychologist significantly
enlarged the boundaries of the therapy, eventually seeing her in 3-4 hour
sessions held 3 days a week. The psychologist also forbade her from taking
medications prescribed by her physician because the medications would interfere
with her "recalling all the experiences on the UFOs which were central to
the therapy." When Myra's savings were depleted, she was forced to
terminate therapy.

On
the other hand the "cognitive interview", which incorporates a
variety of basic techniques derived from experimental research on memory,
appears to hold promise as a method of enhancing memory in eyewitness contexts.
(2)